Each year, Americans spend billions of dollars on treating back pain, even though the malady usually goes away regardless of treatment.
That’s one of the main reasons the latest back pain treatment guidelines recommend that sufferers first seek relief somewhere besides their medicine cabinet. Non-drug therapies, such as physical therapy and stretching exercises, can bring long-term relief without the risks associated with medications.
What Causes Back Pain?
In any three-month period, more than a quarter of U.S. adults experience back pain for at least a day, according to the National Institutes of Health.
Back pain might keep you up at night and disrupt your daily routine, but is rarely a sign of a serious health condition.
Your doctor might tell you your pain stems from degenerative disc disease, but that’s actually a normal part of aging, not a disease. The soft discs, filled with a jelly-like substance, lie between the bones of the spine and act as shock absorbers. MRI studies have shown that nearly everyone over age 60 has some degeneration of the discs, although they don’t necessarily have back pain, according to the Arthritis Foundation.
What the studies have shown is that when patients get an MRI or an X-ray, the majority of the time it doesn’t diagnose the cause.
— Dr. John Mafi, UCLA
Sometimes a disc slips or becomes herniated, which are two different ways of describing the same thing: The disc tears open, and the jelly-like center leaks out, irritating nearby nerves. As with most other reasons for back pain, conservative treatment, as described below, usually resolves the problem.
If the pain persists, though, people sometimes need surgery to remove the part of the disc that is pressing on a nerve. A recent Norwegian study found that patients 65 and older responded just as well to surgery for a herniated disc as younger patients, although they had more minor complications and longer hospital stays.
Other reasons for the pain? “The most common cause is musculoskeletal strain from infrequent activities like shoveling snow, pulling, pushing or lifting,” says Dr. Nitin Damle, president of the American College of Physicians (ACP), a professional organization of internal medicine specialists, which issued the new guidelines.
Sometimes, back pain seems to flare up without any provocation. Instead of overexerting yourself, your problem might be not exerting yourself enough.
“Having a lifestyle where you’re not really moving or stretching the back muscles much, being overweight — these are things that you can correct,” says Dr. John Mafi, an assistant professor in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA. (Getting older is another risk factor for back pain, but, of course, there’s not much you can do about that.)
Tests Not Necessarily Beneficial
If you go to a doctor, he or she might order an MRI or an X-ray to identify the source of your pain. But a half-dozen studies have randomly divided back pain patients into two groups: one in which everyone underwent imaging of their spine and one in which no one did. The studies found no difference between the groups as far as how quickly patients recovered.
Mafi was the first author of an analysis, published in 2013 in The Journal of the American Medical Association, that evaluated trends in how U.S. physicians managed patients’ back pain from 1999 to 2010. The study found greater rates of imaging, referrals to other physicians — presumably for procedures or surgeries that likely were unnecessary — and opioid, or narcotic, painkiller use.
“What the studies have shown is that when patients get an MRI or an X-ray, the majority of the time it doesn’t diagnose the cause and, in fact, it doesn’t help them get better faster or improve their care in any way,” Mafi says.
Back pain usually doesn’t stem from a specific anatomical abnormality that can be pinpointed on an MRI or X-ray, he says. But MRIs are so sensitive that most people have abnormal scans whether or not they have back pain, Mafi says. Those abnormal scans can send doctors and patients on a wild goose chase comprised of more tests and, possibly, unnecessary invasive treatments, he says.
Recommended Treatments Before Drugs
Instead of risky, aggressive treatments, for which evidence of effectiveness is lacking, the new ACP guidelines recommend that you first try these approaches to relieve back pain:
- Superficial heat, the kind you can get from heat wraps sold in drugstores
- Electromyography feedback, a type of biofeedback
- Spinal manipulation, typically performed by a chiropractor
If your pain persists, exercise and physical therapy can also help. Specifically, the guidelines recommend:
- Tai chi, a centuries-old practice, part of traditional Chinese medicine, which involves gentle movements and mental focus, breathing and relaxation
- Progressive relaxation, in which you slowly tense and relax different muscle groups, from your toes to your head
If you’re still in pain, you could add a nonsteroidal anti-inflammatory medication (NSAID) such as ibuprofen (Advil). There is no reason to skip NSAIDs and go directly to opioids, says Damle, a general internist who practices in Wakefield, R.I. Opioids are addictive, and research has shown them to be less effective in treating back pain than NSAIDs, Mafi adds.
Just be sure that you don’t take too much ibuprofen, naproxen or other NSAIDs; they can cause stomach bleeding and kidney damage.
When It Could Be Serious
Remember, in most cases, back pain goes away on its own even if you don’t do anything about it.
But you should consult a doctor about your back pain if any of these conditions apply, Damle and Mafi say:
- Your legs feel weak or numb and you find it difficult to stand. Your back pain could be due to a tumor or mass on your spinal cord that should be removed.
- You have a fever along with the pain. You might have an infection in your back that requires treatment with antibiotics.
- You’ve been diagnosed with cancer. Your back pain could be a sign that your tumor has spread.
- Your back starts to hurt after an accident, such as a fall. You might have sustained a fracture.
“These are really rare,” Mafi emphasizes. “It’s good to see a doctor when you’re concerned, but the vast majority of the time you don’t need to.”
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